Ulrich Friedrich Wellner1, Hryhoriy Lapshyn1, Detlef K Bartsch2, Ioannis Mintziras2, Ulrich Theodor Hopt3, Uwe Wittel3, Hans-Jörg Krämling4, Hubert Preissinger-Heinzel4, Matthias Anthuber5, Bernd Geissler5, Jörg Köninger6, Katharina Feilhauer6, Merten Hommann7, Luisa Peter7, Natascha C Nüssler8, Thomas Klier8, Ulrich Mansmann9,10, Tobias Keck11. 1. Clinic for Surgery, University Clinic Schleswig-Holstein, UKSH Campus Lübeck, 23538, Lübeck, Germany. 2. Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany. 3. Clinic for General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany. 4. Department of General, Visceral and Vascular Surgery, Evangelical Hospital of Düsseldorf, Düsseldorf, Germany. 5. Department of General, Visceral and Transplantation Surgery,, Clinic Augsburg, Augsburg, Germany. 6. Department of General, Visceral, Thoracic, and Transplantation Surgery, Katharinenhospital, Clinic Stuttgart, Stuttgart, Germany. 7. Department of General and Visceral Surgery, Central Clinic Bad Berka, Bad Berka, Germany. 8. Department of General and Visceral Surgery, Endocrine Surgery and Coloproctology,, Clinic Neuperlach, Munich, Germany. 9. Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany. 10. German Cancer Consortium (DKTK), Heidelberg, Germany. 11. Clinic for Surgery, University Clinic Schleswig-Holstein, UKSH Campus Lübeck, 23538, Lübeck, Germany. tobias.keck@uksh.de.
Abstract
PURPOSE: The aim of this study was to assess intraoperative, postoperative, and oncologic outcome in patients undergoing laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) for benign and malignant lesions of the pancreas. METHODS: Data from patients undergoing distal pancreatic resection were extracted from the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. After propensity score case matching, groups of LDP and ODP were compared regarding demography, comorbidities, operative details, histopathology, and perioperative outcome. RESULTS: At the time of data extraction, the StuDoQ|Pancreas registry included over 3000 pancreatic resections from over 50 surgical departments in Germany. Data from 353 patients undergoing ODP (n = 254) or LDP (n = 99) from September 2013 to February 2016 at 29 institutions were included in the analysis. Baseline data showed a strong selection bias in LDP patients, which disappeared after 1:1 propensity score matching. A comparison of the matched groups disclosed a significantly longer operation time, higher rate of spleen preservation, more grade A pancreatic fistula, shorter hospital stay, and increased readmissions for LDP. In the small group of patients operated for pancreatic cancer, a lower lymph node yield with a lower lymph node ratio was apparent in LDP. CONCLUSIONS: LDP needed more time but potential advantages include increased spleen preservation and shorter hospital stay, as well as a trend for less transfusion, ventilation, and mortality. LDP for pancreatic cancer was performed rarely and will need critical evaluation in the future. Data from a prospective randomized registry trial is needed to confirm these results.
PURPOSE: The aim of this study was to assess intraoperative, postoperative, and oncologic outcome in patients undergoing laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) for benign and malignant lesions of the pancreas. METHODS: Data from patients undergoing distal pancreatic resection were extracted from the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. After propensity score case matching, groups of LDP and ODP were compared regarding demography, comorbidities, operative details, histopathology, and perioperative outcome. RESULTS: At the time of data extraction, the StuDoQ|Pancreas registry included over 3000 pancreatic resections from over 50 surgical departments in Germany. Data from 353 patients undergoing ODP (n = 254) or LDP (n = 99) from September 2013 to February 2016 at 29 institutions were included in the analysis. Baseline data showed a strong selection bias in LDP patients, which disappeared after 1:1 propensity score matching. A comparison of the matched groups disclosed a significantly longer operation time, higher rate of spleen preservation, more grade A pancreatic fistula, shorter hospital stay, and increased readmissions for LDP. In the small group of patients operated for pancreatic cancer, a lower lymph node yield with a lower lymph node ratio was apparent in LDP. CONCLUSIONS: LDP needed more time but potential advantages include increased spleen preservation and shorter hospital stay, as well as a trend for less transfusion, ventilation, and mortality. LDP for pancreatic cancer was performed rarely and will need critical evaluation in the future. Data from a prospective randomized registry trial is needed to confirm these results.
Entities:
Keywords:
Laparoscopic distal pancreatectomy; Open distal pancreatectomy; StuDoQ|pancreas registry
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